Clinical Endoscopy

Original Article

Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis: Jake S. Jacob, Michelle E. Lee, Erin Y. Chew, Aaron P. Thrift, Robert J. Sealock; Clin Endosc 2021;54(2):269-274. Published online November 6, 2020; DOI: https://doi.org/10.5946/ce.2020.100

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines.
Methods
We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis.
Results
Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity for choledocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis.
Conclusions
The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers an improved risk stratification tool.

Citations

Citations to this article as recorded by

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원저 / 담도 질환에서 자기공명영상 담도췌관조영술과 내시경적 역행성 담도췌관조영술의 비교 ( Comparison of Magnetic Resonance Cholangiopancreatography with Endoscopic Retrograde Cholangiopancreatography in the Evaluation of the Biliary Tract Diseases ): Korean J Gastrointest Endosc 2001;22(3):152-158. Published online November 30, 2000

Abstract PDF: Background
/Aims: This study was performed to evaluate the diagnostic accuracy and clinical applications of magnetic resonance cholangiopancreatography (MRCP) compared with endoscopic retrograde cholangiopan - creatography (ERCP). Methods: Prior to carrying out ERCP, MRCP was performed on 71 patients and the two examinations were compared using a double blank test, Results: The results revealed that 15 patients had choledocholithiasis, 4 gall bladder stones, 28 cholangiocarcinomas, 12 pancreatic head cancers, 2 ampulla of Vater cancers, 1 gall bladder cancer with ductal invasion, 4 other benign diseases and 5 normal conditions. For the patients with choledocholithiasis, the values of MRCP's sensitivity, specificity and accuracy were 100%, 9S.2% and 98.6%, respectively, and those of ERCP's were all 100%, For the patients with malignant obstructions, the values of MRCP's sensitivity, specificity and accuracy were 90.7%, 100% and 94.4%, respectively, and the values of ERCP's were 95.3%, 92.9% and 94.4%. Conclusions: These data show that MRCP has a rather high sensitivity, specificity and accuracy in the diagnosis of the biliary tract system, and therefore MRCP can be substituted for ERCP in the aspect of diagnosis (Korean J Gastrointest Endosc 2001;22:152 - 158)

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